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Workplace Wellbeing Focus: Psychological help 5 in 5

Sep 5, 2017, 12:27 PM

by Dr Joe Buckman, Clinical Psychologist

Psychological health in the workplace

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Dr Joe Buckman is an experienced Clinical Psychologist and founder/ director at Psych Health. He works as a clinical psychologist within Occupational Health in a variety of public and private sector organisations, both with individuals who are experiencing difficulties and with organisations in terms of informing mental health strategy. He specialises in the psychological assessment and treatment of employees with mental health difficulties within the workplace.

1. The charity MIND highlights the fact that that one in six workers in the UK experiences common mental health problems, including anxiety and depression. What, in your experience, have been particularly effective new innovations, in terms of early support for people experiencing early symptoms of anxiety and depression?

The key issue is in my view is one of service design – what kind of support, when, and how? Traditionally, workplace-based mental health support has taken place in something of a vacuum, separated from key aspects of someone’s care, e.g. OH and HR/ the business, resulting in there being little ability to help support someone experiencing mental health difficulties within the workplace other than sending them off for treatment. Our clients’ experience was that people would often ‘disappear into a black hole’, making it difficult to manage from an organisation perspective. What we and our clients have found to be particularly effective is what we think of as an integrated model of service delivery, in which we work with all other parts of the system as well as the employee, including HR and OH, to deliver high quality psychological treatments that are both work-focused, where work-related issues exist, and also link to the workplace in terms of providing timely feedback to OH to assist in advising the business how best to support the individual. We also work with HR on a more strategic level, delivering workshops to ensure that the HR community is able to identify issues as quickly as possible and signpost the individual to the appropriate care. This model of service delivery has huge benefits for individual and organisational outcomes.

2. CBT is a type of talking therapy that we hear a lot about. Can you explain what essentially CBT is, and what types of mental health conditions it can help with?

CBT is a type of talking therapy that is essentially based on the premise that it is not what happens to us that is important in terms of how we feel, but the way we think about it, and react to it. It is more practical than some other forms of therapy, helping the individual identify and challenge unhelpful ways of thinking (Cognition) and reacting (Behaviour) that contribute to emotional distress.

It has been found to be helpful with a range of mental health conditions, such as depression, anxiety, phobias, OCD and trauma, to name but a few. I would emphasise caution, however, around the tendency to assume that CBT would be helpful for all individuals with these conditions, as the research does not support the notion that 100% of individuals with a given condition are helped by it. There are a range of other factors involved in the question of what type of psychological therapy someone might need, and this requires appropriate clinical assessment.

3. What other types of talking therapy are commonly used in the treatment of people with MH conditions and how can employees access them?

There are almost as many brands of psychological therapy as there are washing powders in the supermarket! Mostly, all are derived from the 3 main ‘schools’ of psychotherapy – psychodynamic, systemic, and cognitive-behavioural, though may ‘look and feel’ different in terms of the specific focus and technique. Common forms of therapy include CBT, psychodynamic psychotherapy, systemic therapy, acceptance and commitment therapy (ACT), cognitive-analytic therapy (CAT), eye movement desensitisation reprocessing therapy (EMDR), dynamic interpersonal therapy (DIT), interpersonal therapy (IPT), narrative therapy, solution-focused brief therapy etc.

The important issue in my view is that we ensure an appropriately qualified clinician makes the decision on what treatment is required for any one individual. If a therapist is only trained in one approach, this can be limiting in determining what someone actually needs, rather than simply fitting everyone into the same model, which may not necessarily suit them. The old saying comes to mind – “if you are a hammer then everything you see is a nail”. This does not seem an appropriate approach to mental health care to me.

4. More employers are recognising the relationship between cognitive function and performance, and mental health. What types of assessment are useful when trying to ascertain what adjustments can be made to reduce the impact of these on an employee’s mental wellbeing and productivity?

Executive function (i.e. ‘higher’ mental processes such as planning, ordering, executing tasks) can be affected by a range of issues, from the more ordinary such as tiredness and being hung over, to more serious organic causes of cognitive decline, for example related to stroke, head injury, or the onset of dementia. In between these two extremes, individuals who are stressed, depressed or anxious may also experience cognitive issues.

We usually recommend the individual undergo a ‘screening’ psychological assessment to formulate the possible reasons for the perceived decline in cognitive performance. Often, this may be related to someone feeling stressed, depressed or anxious, and this may necessitate some psychological treatment, as well as advice to OH around what support the individual may benefit from within the workplace.

Where concerns around decline in cognitive ability cannot be attributed to mental health issues, or where there may have been undiagnosed cognitive functioning problems (such as dyslexia) or there has been a medical issue such as a stroke or a head injury, we would recommend in-depth cognitive/ neuropsychological testing to determine the exact nature and extent of this. This consists of usually extensive testing of memory, general ability, executive function and other aspects of cognitive functioning, to determine an individual’s relative strengths and weaknesses against their expected profile, and to highlight areas where they might require support in the workplace in terms of restrictions and adjustments. The nature of the adjustments needed will vary hugely depending on the nature of the cognitive difficulty in question, from temporary reductions in workload in cases where someone’s cognitive decline is stress-related, to medical retirement in cases where someone’s cognitive functioning has changed to the point where they are no longer able to perform the same role, for example after a head injury.

5. Work demands are one of many contributing factors which impact on an employee’s mental wellbeing. In your experience, working with patients every day, what other socioeconomic factors would you say now play an important role in mental wellbeing?

This is a complex question that researchers have shown increasing interest in as we have moved away from a purely medical understanding of mental illness, and towards one in which socioeconomic factors have been found to play a huge role in the development of mental illness.

Within the context which I currently work, which is predominantly the workplace, we are seeing more people who are facing significant pressures around their finances, housing, restricted career choices and reduced family time as a consequence of financial pressures. These can be associated with significant levels of distress in the population we work with, where it feels ever more difficult to feel secure socioeconomically.